Evaluating Investments in Health Care Systems: Health Technology Assessment

By Alessandro Scaletti

This book focuses on the innovative and more critical management approach adopted in the PA (Public Administration) in order to identify and describe the main models and instruments to economically evaluate the decision making process in accordance to the specific conditions such as efficiency, effectiveness, cost and equity. The manuscript pays special attention to this sector by identifying, investigating and applying the main evaluation models (logic and methods) of the decision making process, in particular in terms of investment decisions. In the recent decades, with reference to PA, several managerial approaches have been developed from a business management perspective. These managerial approaches differ in terms of variables analyzed, such as the role of governance or the specific logics and mechanisms applied, but all of them have a common goal, which is the improvement of efficiency, effectiveness, economic and equitable decision making and operations in the PA. This book investigates the different mentioned frameworks adopting a wider and integrated analysis perspective on the evaluation of investments in the health care system.

• Language: English
• Publisher: Springer
• Release date: Jul 8, 2014
• ISBN: 9783319025445

Book preview

Alessandro ScalettiSpringerBriefs in Health Care Management and EconomicsEvaluating Investments in Health Care Systems2014Health Technology Assessment10.1007/978-3-319-02544-5© The Author(S) 2014

SpringerBriefs in Health Care Management and Economics

Series EditorJoseph K. Tan

For further volumes: http://​www.​springer.​com/​series/​10293

Alessandro Scaletti

Evaluating Investments in Health Care SystemsHealth Technology Assessment

A319580_1_En_BookFrontmatter_Figa_HTML.gif

Alessandro Scaletti

Department of Business Management, University of Naples Parthenope, Naples, Italy

ISSN 2193-1704e-ISSN 2193-1712

ISBN 978-3-319-02543-8e-ISBN 978-3-319-02544-5

Springer Cham Heidelberg New York Dordrecht London

Library of Congress Control Number: 2014932977

© The Author(S) 2014

SIP title

The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

Printed on acid-free paper

Springer is part of Springer Science+Business Media (www.springer.com)

For Prof. Gennaro Ferrara

Preface

In the current context of international economy crisis, the control of public expenditure appears to be now a diktat imposed by finance institutions, to ensure continued economic growth and, at least, maintain the levels of well-being achieved by individual nations.

In these scenarios, the economic evaluation of public and private decisions, if equipped with collective importance, enters fully into the behavioral ethics of the policy makers and technocrats called upon to manage the public sector.

In recent years, several approaches have been developed, in a business management perspective, for the study and innovation of Public Administration (PA).

These frameworks of ideas, apart from some significant conceptual differences, have in common the goal of improving efficiency, effectiveness, economic and equitable decision-making, and operations implemented by the various companies that make up the Public Administration.

The differences mentioned in the approaches refer to the combination of the importance that certain variables undertake in the different analytical frameworks. The variables analyzed in this work are due to the different role of governance assumed by public entities in the network of relationships, which are the central node, and the logic and mechanisms through which these bodies, in accordance with the conditions of efficiency, effectiveness, cost, and equity, protect and control public interest.

With reference to the first variable, a central vision of public administration, understood as a structured body in which allocation decisions of resources among its subjects are made by an organization/institution at the center of the constellation, is opposed to a vision of PA with less rigid boundaries, in which the public and private entities involved align their aims in compliance with public interest through a process of delegation and co-participation decision logic.

With reference to the other variable, in the various PA approaches studied, there is an alternation of logic that for some areas of research, equitable economic protection of public interest is entrusted to the introduction of competitive mechanisms, while for others the same objective is achievable through the strengthening of collaborative logic of those who form the PA.

Starting with the study of international management on the evolution of PA, this work aims to study the evolution of decisional logic that has affected the NHS and the analysis of the approach used in support of decision better known as Health Technology Assessment (HTA).

Therefore, in the first part, this work describes how the different approaches, succeeding one another over time, in the study of public administration, have influenced the evolution of logic and the tools used to support public decision.

This introductory part presents the theoretical framework of reference, on which the sample model used to illustrate how the evolution of management theories has influenced the decision-making processes related to the selection of the different allocative solutions to be applied to the healthcare systems on which it is based.

In the next part, a sample model for the study of public decision in healthcare is proposed: HTA.

However, the theory and the practical evidence in the work undoubtedly show that the assessment tools alone may not be sufficient for the containment of public expenditure, nevertheless, they represent a valid modus operandi for a more effective and efficient allocation of resources, poor by definition, among the various possible uses, in function of the current and future needs of the community.

In conclusion, I would especially like to thank Prof. Giorgio Liguori, Professor of Hygiene at my University, for his invaluable support in the study of healthcare technologies and Dr. Patrizia Belfiore, as well as other colleagues of the Territorial Institutions Department with whom the work reported in this document was carried out.

To each and everyone I extend my sincere thanks, it being understood that I take exclusive responsibility for inaccuracies or omissions that may be present in the work.

Alessandro Scaletti

Salus populi suprema lex,

from the Laws of the XII tables

Rome 451 a.C.

Alessandro Scaletti

Health Technology Assessment.

Logic and methods of evaluation

Contents

1 The Evolution of Decisional Logic in the Healthcare System 1

1.​1 Introduction 1

1.​2 The Cultural Change of the ’90s.​ Managerialism 4

1.​3 The Growth of Business Logic in Decision-Making 8

References 15

2 Logic and Methods of Evaluation in Healthcare 19

2.​1 Evaluation Issues in Health 19

2.​2 The Role of Economic Analysis in Healthcare Processes 21

2.​3 The Main Techniques of Economic Evaluation in Healthcare 22

2.​3.​1 Analysis of Cost Minimization 29

2.​3.​2 Cost-Benefit Analysis 31

2.​3.​3 Cost-Effectiveness Analysis 33

2.​3.​4 Cost-Utility Analysis 34

2.​4 Research Perspectives of Economic Evaluations 36

References 38

3 Health Technology Assessment 39

3.​1 HTA:​ Birth and Evolution 39

3.​2 Current Situation and Prospects for Development 44

3.​3 HTA and Technological Appropriateness 49

3.​4 HTA and Decision-Making Processes 52

3.​4.​1 The Implementation of a HTA Process 56

3.​5 Multi-Disciplinary Aspects of a HTA Process 59

References 61

Alessandro ScalettiSpringerBriefs in Health Care Management and EconomicsEvaluating Investments in Health Care Systems2014Health Technology Assessment10.1007/978-3-319-02544-5_1

© The Author(S) 2014

1. The Evolution of Decisional Logic in the Healthcare System

Alessandro Scaletti¹  

(1)

Department of Business Management, University of Naples Parthenope, Naples, Italy

Alessandro Scaletti

Email: [e-mail]

Abstract

In the current context of international economy crisis, the control of public expenditure appears to be now a diktat imposed by finance institutions, to ensure continued economic growth and, at least, maintain the levels of well-being achieved by individual nations. In these scenarios, the economic evaluation of public and private decisions, if equipped with collective importance, enters fully into the behavioral ethics of the policy makers and technocrats called upon to manage the public sector. In recent years, several approaches have been developed, in a business management perspective, for the study and innovation of Public Administration (PA). These frameworks of ideas, apart from some significant conceptual differences, have in common the goal of improving efficiency, effectiveness, economic and equitable decision-making and operations implemented by the various companies that make up the Public Administration.

Keywords

New public managementPublic governancePublic choicePublic administrationEfficiencyEffectiveness

1.1 Introduction

In the current context of crisis of national economies, the control of public expenditure appears to be now a diktat imposed by financial institutions to ensure continued economic growth and, at least, maintain the levels of well-being achieved by individual nations.

In these scenarios, the economic evaluation of public and private decision, if equipped with collective importance, enters fully into the behavioral ethics of policy makers and technocrats called upon to manage the public sector. Therefore, the approaches and instruments of economic evaluation do not appear to be simply the tools at the disposal of political choice, but the real object of the latter in an attempt to harmonize and make the relationship between means and purposes more transparent.

Undoubtedly, the assessment tools alone cannot be sufficient for the containment of public expenditure, nevertheless they represent a valid modus operandi for a more effective and efficient allocation of resources, poor by definition, among the various possible uses, depending on the, actual and future, needs of the community.

The central role of healthcare spending, in the decision of public finance, has always generated a keen interest in economic studies first, and then in managerial ones, on the role that the characteristics of the organization of health services has on the levels of public spending, as well as on the quality of services provided for citizens.

For the social and economic importance assumed, regardless of the national context of reference, the healthcare organization in each country is at the center of a